Research Reports (1997): Health Studies, Vol - XXI

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    Quality assessment of BRAC Health Centres
    (BRAC Research and Evaluation Division (RED), 1997-11) Afsana, Kaosar; Mahmud, Shah Noor; Chowdhury, AMR; Karim, Fazlul; Khan, Suhaila H
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    Men’s perceptions about family planning
    (BRAC Research and Evaluation Division (RED), 1997-10) Shahaduzzaman
    This study looked at the men's perception on family planning, their knowledge and opinion about different contraceptives, as well as the motivating factors of the male for accepting family planning. Information was collected in December 1996 from Sherpur district through informal discussions, focus group discussions with men below and above the age of 40 years, religious leaders and with Garo ethnic group. Case histories of 6 condom users and 6 vasectomised clients were also taken. Men generally have a positive attitude towards family planning. They have definite ideas about optimal family size and own fertility, and also have a high knowledge on contraceptives. This knowledge mostly appeared to be superficial. Though there was a trace of the feeling in men that contraceptives were women's responsibility. Men were not properly by the programmes. Thus lack of information and under the influence of rumors their supportive and user roles were hampered. The perceived limitation of male contraceptive choice was also a major determinant of male contraceptive use. However, the male method users were gen;:rally satisfied with their methods. The depotholders of BRAC were found to be popular and well accepted by the male community, though their role was not properly known by men. Male forums and male contact were found to be inadequate. There was a gross misconception about the family planning registration card given by BRAC. To well publicize services and to promote the male contraceptives, to fulfill knowledge gap about BRAC's Family Planning Facilitation Programme by strengthening male forums were recommended.
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    TBA programmes: a comprehensive literature review
    (BRAC Research and Evaluation Division (RED), 1996-12) Khan, Suhaila H; Islam, Md Nazrul; Ali, Ahmad; Karim, Fazlul
    Of the 500,000 women who die every year due to pregnancy related causes 99% live in developing countries. Most deliveries in developing countries are non-institutional and take place at home by traditional birth attendants (TBA). With the expectation cf decreasing maternal mortality TBA training programmes were started in many developing countries. The objectives of this literature review was to identify the issues in TBA programmes, and also identify the gaps in research conducted so far. This review encompasses three perspectives: global, Government of Bangladesh, and non-government organizations specially BRAC. The review identified the following programme relevant issues: bin:h attendants and practices; evolution of TBA programmes; programme objectives; structure of TBA programmes (type of service, service providers and recipients); service giving process: training (target population, trainee selection criteria, course schedule and content, incentives for this work, TBA perceptions about birth process, trainers, monitoring and supervision of TBAs); outcome of TBA training programmes (impact on maternal and infant mortality and morbidity indicators, client satisfaction, change in KAP of trained TBAs (TTBA), evaluation of TTBA's performance, utilization of TTBAs, TTBAs' linkage with other health workers; and cost effectiveness of TBA programmes.
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    The story behind the Shasthyo Shebika dropouts: (training and retaining Shasthyo Shebika: reasons for staff turnover)
    (BRAC Research and Evaluation Division (RED), 1997-03) Khan, Suhaila H; Chowdhury, AMR; Karim, Fazlul; Barua, Milon Kanti
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    Financing the BRAC Health Centres: their financial sustainability and cost-effectiveness
    (BRAC Research and Evaluation Division (RED), 1998-01) Khan, Suhaila H; Mahmud, Shah Noor; Karim, Fazlul; Afsana, Kaosar
    The Health ana Population Division (HPO) of BRAC aims to provide supportive secondary level health care services for the community through the BRAC Health Centres (BHCs) or Shushasthyos. The BHCs began operating in HPO areas in 1995. As of January 1998 there were 27 BHCs. All BHCs function through user fees in order to make the BHCs financially sustainable in the long run. HPD is endeavoring strategic planning in order to reduce donor dependence and meet the projected resource gaps through the implementation of certain systems such as, cost recovery and cost sharing through the BHCs, to ensure financial sustainability in the long run. The Research and Evaluation Division (RED) of BRAC aimed to evaluate how much cost recovery was occurring at the BHCs which contributed to BHCs' financially sustainability, and what modifications need consideration to support enhance this sustainability. This was a health facility based study done in 9 BHCs in three regions. Mymensingh, Bogra and Dinajpur. The variables considered for this study were related to cost. revenue, cost sharing and effects. The average or unit cost of operating a BHC was Tk. 422.092. The recurrent cost was Tk. 403 ,547 and capital cost was Tk. 18,545. Average income per BHC was Tk. 89,631. The cost recovery was 22% of recurrent costs and 21% of total costs. And if we considered the variables similar to HPD then cost recovery was 35% of recurrent costs and 33% of total costs. 23% of the indicators mentioned in the monthly disease profile cover gynaecologicals conditions. These constitute about 11% of the total general diseases being identified and/or treated at the BHCs. This is only possible due to having a facility such as a BHC. The unit cost per patient visit was Tk. 93. Some interventions, such as ANC and GM done at BHCs seemed to be cheaper compared to previous findings of WHOP and RDP-PHC.